Dude, where’s my parathyroid?

The parathyroid glands are a small but mighty part of the
endocrine system that are very important to your health. Typical people have
four parathyroid glands, a pair on each side of the neck located behind the
thyroid. The glands produce a substance called PTH, or parathyroid hormone. PTH
is the most important regulator of blood calcium levels.

What is hyperparathyroidism?

Hyperparathyroidism occurs when one or more of your
parathyroid glands becomes overly active and releases too much PTH. This
creates a calcium imbalance that the body cannot correct on its own. This is
the leading cause of hypercalcemia (excess of calcium in the blood), especially
in women over 50 years old.

What are the symptoms of hyperparathyroidism?

Hypercalcemia makes it difficult for the body to carry out
its normal functions. Extremely high levels of calcium can be life-threatening. Symptoms are widespread throughout the
systems of the body.

Types of hyperparathyroidism

Hyperparathyroidism is classified into three distinct
groups. Primary hyperparathyroidism is a relatively common disorder with
widespread symptoms that affect every organ. Typical symptoms include fatigue,
bone pain, gastrointestinal upset, memory loss and, in some cases, kidney
stones. Treatment is a relatively simple surgical procedure that often takes
only fifteen minutes.

Secondary hyperparathyroidism is also caused by an
overactive parathyroid gland. This is a result of low calcium levels. Therefore,
your parathyroid glands overwork to compensate for the loss of calcium. Secondary
hyperparathyroidism is often the result of kidney failure but it is far less
common than primary or even tertiary hyperparathyroidism.

Tertiary hyperparathyroidism occurs more than secondary
hyperparathyroidism but it is also rare and is seen in patients with renal
disease and post kidney transplant. Because it is a rare problem, guidelines
for surgical treatment and prognosis have not been well repeated in the past.

Systematic review

In a scholarly and systematic review, Dr. Friedman and
associates studied outcomes of hundreds of patients with tertiary
hyperparathyroidism who underwent a parathyroidectomy (removal of the
parathyroid gland). Control of symptoms and hypercalcemia cure rates were as
high as 94% in many studies.

What are the
implications of this study?

In primary hyperparathyroidism, typically one parathyroid
gland is abnormal and the other three are normal. Surgery is a simple matter of
removing the abnormal gland. In tertiary hyperparathyroidism, all four glands
are abnormally enlarged. A surgical decision must be made as to how much
parathyroid tissue to remove. Medical controversy surrounds this issue. In some
cases, parathyroid tissue is removed from the neck and autotransplanted to the
forearm to regulate calcium levels but allow easy surgical access if
hypercalcemia recurs. The indication of surgery and the amount of gland removed
was previously not established.